Psoriasis

Psoriasis results from immune dysregulation in which specific immune proteins, including TNF-α, IL-17, and IL-23, drive rapid skin cell turnover and inflammation. It has a strong genetic component and typically requires an environmental trigger to manifest or flare. Common triggers include skin trauma (the Koebner response, where new plaques form at injury sites), streptococcal infections, stress, certain medications, smoking, and excess alcohol.

How is it diagnosed?

In most cases, an experienced dermatologist can diagnose psoriasis through clinical examination. A skin biopsy may be performed if the diagnosis is uncertain. Joint symptoms such as stiffness, swelling, or pain in the fingers, toes, or larger joints are always considered in the assessment, as early identification of psoriatic arthritis is important to prevent joint damage.

The goal of modern treatment is meaningful improvement in quality of life alongside skin clearance.

Topical treatments, including corticosteroids, vitamin D analogues, and combination products, are first-line for mild or limited psoriasis.

Phototherapy (controlled light exposure) can be effective for more widespread psoriasis and is delivered in a clinical setting.

Systemic oral treatments including methotrexate, deucravacitinib, apremilast, acitretin and cyclosporin remain appropriate options for moderate to severe disease.

Biologic therapies target the specific immune pathways driving psoriasis, particularly IL-17 and IL-23, and have demonstrated high levels of skin clearance. Several biologic options are available in Australia. Your dermatologist will assess whether biologic therapy is appropriate, considering your health, disease severity, and personal priorities.

Psoriatic arthritis is typically managed in collaboration between dermatology and rheumatology.

Treatment is highly individual and goals may evolve over time. Your dermatologist will help you find an approach that fits your life.